• Productive remote contributor with demonstrated ability to independently research, analyze and troubleshoot complex EDI-related issues within a large health-care production environment• Implemented process improvement initiatives that streamlined billing and collections and improved revenue cycle time by 43%• Interacted with internal departments, vendors and trading partners as required to increase the existing number and percentage of electronic claims and payments• Interfaced with IT and Practice Management system vendor NextGen to maintain an electronic benefits verification system as well as on-boarding of new and existing clinic affiliates • Coordinated with vendors on the testing and implementation of EDI transactions with new and existing trading partners

• Responsible for resolving escalated errors arising from discrepancies identified by the Center for Consumer Information and Insurance Oversight Enrollment Resolution & Reconciliation project as it related to the Federally Facilitated Marketplace• Analyzed and reconciled various types of enrollment data discrepancies to produce complete enrollment records with accurate data maintained by the Federally Facilitated Marketplace• Actively participated in development, implementation, documentation and support of three individual work streams • Served as a regional team leader for the Orphan Enrollment Resolution process supervising seven associates• Conducted training sessions, served as a Subject Matter Expert for enrollment resolution and completed quality analysis of finalized work• Selected as a member of the Business Process Rules Team to interface directly with representatives from the Centers for Medicare & Medicaid Services and the Center for Consumer Information and Insurance Oversight for the development of project guidelines and process automation

• Led testing team activities regarding the efficacy of the Federally Facilitated Marketplace application also known as the Health Insurance Exchange• Interfaced operationally and technically with key stakeholders such as Centers for Medicare & Medicaid Services representatives, program management, private insurance companies and various exchange contractors during development and implementation of the software application• Directed efforts for all test plans and test case scenarios used by participants from the insurance community for all testing phases• Supplied subject matter expertise and guidance in all procedures related to application testing

• Processed and reconciled comprehensive claims payment process, which generated millions of reimbursement dollars and was highly visible across the organization• Responsible for organization, implementation, execution and supervision of activities related to exchange of electronic data, including claims, eligibility, remittance and other mission critical data• Acted as primary point of contact for clearinghouse and provider trading partners to ensure customer satisfaction and data integrity• Generated operational policies and procedures to achieve best practices• Conducted test cases for integrated, regression, end user acceptance and release testing phases• Manipulated software systems, conducted SQL queries and executed Data Transformation Services (DTS) packages in order to select, process, produce and validate ASC X12 health care data files as well as proprietary e-commerce transactions in production and testing business system environments• Developed and implemented process improvement plans to track EDI claim rejections which resulted in a significant reduction in volume of rejected claims and brought turnaround times within applicable guidelines

• Analyzed EDI transaction files to identify errors in data, transmission, payer edits and mapping• Communicated technical errors, conveyed technical specifications and reviewed and validated test file results with direct trading partners• Implemented recommendations for resolving inconsistencies resulting in the substantial reduction of the erroneous rejection of claims• Examined payer edit inquiries, researched technical specifications and formulated recommendations resulting in a clear definition of requirements and processes• Monitored performance of clearinghouse trading partners for error trending and troubleshooting where abnormalities were detected • Removed obstacles to promote volume and revenue growth